Airway management in ICU setting

Checking for airway patency may be life saving in certain situations which may be mistaken for other conditions like an acute coronary syndrome. Usual cause of airway obstruction in an uncoscious patient is falling back of the tongue. Head tilt and chin lift / jaw thrus will help in this situation. But head tilt should not be used in trauma.

If the oropharyngeal reflexes are not adequate, an oropharyngeal airway is useful. If oropharyngeal airway is not suitable, a nasopharyngeal airway can be used. Advanced airways are considered if even this is not suitable. Advanced airways are endotracheal tubes, laryngeal marks and combi-tubes.

E-C clamp for holding chin and Ambu bag while giving ventilation. E shape of fingers holding the chin and C shape of fingers holding the mask.

RSI: rapid sequence intubation

Sellick’s maneuver: cricoid pressure during intubation to prevent aspiration of regurgitated stomach content.

Rescue airways: gum elastic bougie, laryngeal mask airway (LMA), combitube. Combitube and LMA are blind intubation devices. In case of combitube, it is immaterial whether it goes into the esophagus or the trachea. If it goes into the esophagus, distal cuff inflation permits air to reach the trachea. If it goes into the trachea, ventilate just like in case of an endotracheal tube.

In trauma cases, cervical spine protection should not be forgotten. One person should stabilise the spine while another person is intubating.

Needle Cricothryotomy is useful in an emergency to secure an airway. High frequency ventilation is used through this airway to buy time for planning a regular tracheostomy.

Confirmation of airway postion

Always confirm the airway position by ausculation, starting from the stomach and then over the chest, during trial ventilation (exclude wrong postion first!). Esophageal detector devices are also useful in checking whether the airway is in the wrong postion.

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